Clinical Features and Prognosis of Acute Macular Neuroretinopathy Associated with Novel Coronavirus Infection

Minhui ZHANG; Weidan YIN; Zhulin HU; Hua LI; Liwei ZHANG; Yuling REN

doi:10.12259/j.issn.2095-610X.S20250412

Volume 46 Issue 4

Apr. 2025

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Article Navigation > Journal of Kunming Medical University > 2025 > 46(4): 90-98

Minhui ZHANG, Weidan YIN, Zhulin HU, Hua LI, Liwei ZHANG, Yuling REN. Clinical Features and Prognosis of Acute Macular Neuroretinopathy Associated with Novel Coronavirus Infection[J]. Journal of Kunming Medical University, 2025, 46(4): 90-98. doi: 10.12259/j.issn.2095-610X.S20250412

Citation:

Minhui ZHANG, Weidan YIN, Zhulin HU, Hua LI, Liwei ZHANG, Yuling REN. Clinical Features and Prognosis of Acute Macular Neuroretinopathy Associated with Novel Coronavirus Infection[J]. Journal of Kunming Medical University, 2025, 46(4): 90-98. doi: 10.12259/j.issn.2095-610X.S20250412

Citation:

Minhui ZHANG, Weidan YIN, Zhulin HU, Hua LI, Liwei ZHANG, Yuling REN. Clinical Features and Prognosis of Acute Macular Neuroretinopathy Associated with Novel Coronavirus Infection[J]. Journal of Kunming Medical University, 2025, 46(4): 90-98. doi: 10.12259/j.issn.2095-610X.S20250412

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Clinical Features and Prognosis of Acute Macular Neuroretinopathy Associated with Novel Coronavirus Infection

doi: 10.12259/j.issn.2095-610X.S20250412

Department of Ophthalmology，The Affiliated Hospital of Yunnan University，The Second People’s Hospital of Yunnan Province，Yunnan Eye Hospital，Kunming Yunnan 650021，China

Received Date: 2024-12-10
Available Online: 2025-04-06
Publish Date: 2025-04-25

Abstract

Abstract

Objective To Observe the clinical characteristics and prognosis of patients with the acute macular neuroretinopathy （AMN） associated with novel coronavirus infection（COVID-19）. Methods The data of 13 patients diagnosed with COVID-19-associated AMN attending the Department of Ophthalmology of the Affiliated Hospital of Yunnan University from December 2022 to February 2023, as well as 13 case reports in PubMed and Web of Science databases from 2020 to 2023 and a case series study totaling 41 patients were retrospectively selected and analyzed for their ophthalmic imaging and prognostic outcomes in clinic. Results A total of 13 cases with 25 eyes in the clinical case group were included in the study with a mean age of 30.23±6.02 years, of which 10 were females. The literature case group consisted of 41 cases and 72 eyes with a mean age of 30.12±13.24 years, including 31 female patients. （1） Duration between COVID-19 symptoms/diagnosis and ophthalmic symptoms: 3（2.0, 4.0） days in the clinical case group and 2 （0.75, 5.0） days in the literature case group. （2） Clinical characteristics: 12 （92.31%） of the clinical case group had the binocular onset and the literature case group, 31 （75.61%） had the binocular onset. The symptoms in both groups were mainly dark spots in vision, followed by decreased visual acuity. （3） Ancillary examinations: optical coherence tomography （OCT） showed the ellipsoid zone （EZ） and/or chimeric zone （IZ） breaks with strong reflections in the outer plexiform layer （OPL） and outer nuclear layer （ONL） in 13 patients in the clinical case group, and the near-infrared photography （NIR） showed the low-reflective wedge-shaped foci around the center of the macula, and some patients' optical coherence tomography angiography （OCTA） showed deep capillary lesions, and some patients' OCTA showed low reflectivity. Reduced blood flow in the deep capillary layer （DCP） and choroidal capillary layer （CC） was observed in all patients, 7 patients with cotton-wool spots also had the reduced blood flow in the superficial capillary layer （SCP）, and 33 patients in the case group in the literature had the visible EZ and/or IZ breaks on OCT. （4） Treatment and prognosis: 11 out of 13 patients were treated with oral glucocorticoids, 2 were under the observation. After year, the condition of 23 patients had been improved, 1 case had visual field defects, 1 case had retinal vein occlusion secondary to macular edema, and 1 case had a hyporeflective signal in the outer nuclear layer （ONL） and outer plexiform layer （OPL）. Conclusion The age of onset of AMN related to COVID-19 is slightly older, with more cases involving both eyes. The main symptom is visual field scotoma, often accompanied by decreased vision. Near-infrared imaging shows low-reflective wedge-shaped lesions around the fovea, and OCT shows mainly disruption of the EZ and/or IZ. OCTA shows decreased blood flow density in the DCP and CC layers. The visual prognosis of AMN related to COVID-19 is good, but vigilance is needed for the occurrence of complications such as retinal vein occlusion
- SARS-CoV-2,
- COVID-19,
- Acute macular neuroretinopathy,
- Clinical features,
- Prognosis

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References(44)

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